Basic Information
| Provider Information | |||||||||
| NPI: | 1568482271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOAKUM | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | SPENCER | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 8667954020 | ||||||||
| Practice Location | |||||||||
| Address1: | 1033 RANDOLPH ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364750151 | ||||||||
| FaxNumber: | 3364757539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 1635 | NC | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | 1635 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 18768 | 01 | NC | PARTNERS | OTHER | 22819 | 01 | NC | OPTICARE | OTHER | 5609966 | 01 | NC | CIGNA | OTHER | 890900A | 05 | NC | MEDICAID | 2208350 | 01 | NC | UNITED HEALTHCARE OF NC | OTHER | 0900A | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER |